Malignant spinal cord compression: Difference between revisions
m (Rossdonaldson1 moved page Malignant Spinal Cord Compression to Malignant spinal cord compression) |
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*Metastatic Bone Cancers | *Metastatic Bone Cancers | ||
**BTL w/ Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal | **BTL w/ Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal | ||
==Differential Diagnosis== | |||
{{Oncologic emergencies DDX}} | |||
==Treatment== | ==Treatment== |
Revision as of 22:27, 4 March 2015
Background
- Suspect in pt w/ known cancer (esp lung, breast, prostate) + back pain
- Occurs in thoracic location in 70% of pts
Clinical Features
- Back pain (90% of pts)
- Progressive and worse when supine
- Motor weakness (proximal legs)
- Sensory changes and bladder or bowel dysfunction (late findings)
Diagnosis
- MRI: modality of choice
- CT myelography: use if MRI unavailable
- Metastatic Bone Cancers
- BTL w/ Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Treatment
- Corticosteroids
- Dexamethasone 10mg IV followed by 4mg PO or IV q6hr
- Consider starting in ED if imaging is delayed
- Radiotherapy (emergent)
See Also
Spinal Cord Compression (Non-Traumatic)
Source
Tintinalli